Commentary: CS can cause miscarriage, stillbirth, and early infant death. It also is an indicator of the increase in syphilis among adults in the United States over the last three years. To decrease the rate of congenital syphilis, there must be appropriate screening and treatment of both sexually active adults as well as screening pregnant women as a part of prenatal care. The CDC recommends all pregnant women be screened for syphilis at their first prenatal visit. Women at increased risk for syphilis should also be screened at the beginning of their third trimester and again at delivery (1). That said, approximately a fifth of CS cases occurred where the mother never received prenatal care. The CDC recommendations for general syphilis screening are: Screening at least once a year for all sexually active gay, bisexual, and other men who have sex with men (MSM). MSM who have multiple or anonymous partners should be screened more frequently for STDs (ie, at 3- to 6-month intervals). The USPSTF recommends screening for, “persons at increased risk for syphilis infection” and describes increased risk as, “men who have sex with men and engage in high-risk sexual behavior, commercial sex workers, persons who exchange sex for drugs, and those in adult correctional facilities.” (2). There is not currently a general recommendation for syphilis screening for all women. —Neil Skolnik, MD

1. Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64 (No. RR-3).

2. Syphilis Infection: Screening . http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/syphilis-infection-screening.